title: Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children.
abstract: OBJECTIVE
  Our objective was to demonstrate that, despite recognition by both the gastroenterology and headache communities, abdominal migraine (AM) is an under-diagnosed cause of chronic, recurrent, abdominal pain in childhood in the USA.
  
  
  BACKGROUND
  Chronic, recurrent abdominal pain occurs in 9-15% of all children and adolescents. After exclusion of anatomic, infectious, inflammatory, or other metabolic causes, "functional abdominal pain" is the most common diagnosis of chronic, idiopathic, abdominal pain in childhood. Functional abdominal pain is typically categorized into one, or a combination of, the following 4 groups: functional dyspepsia, irritable bowel syndrome, AM, or functional abdominal pain syndrome. International Classification of Headache Disorders--(ICHD-2) defines AM as an idiopathic disorder characterized by attacks of midline, moderate to severe abdominal pain lasting 1-72 hours with vasomotor symptoms, nausea and vomiting, and included AM among the "periodic syndromes of childhood that are precursors for migraine." Rome III Gastroenterology criteria (2006) separately established diagnostic criteria and confirmed AM as a well-defined cause of recurrent abdominal pain.
  
  
  METHODS
  Following institutional review board approval, a retrospective chart review was conducted on patients referred to an academic pediatric gastroenterology practice with the clinical complaint of recurrent abdominal pain. ICHD-2 criteria were applied to identify the subset of children fulfilling criteria for AM. Demographics, diagnostic evaluation, treatment regimen and outcomes were collected.
  
  
  RESULTS
  From an initial cohort of 600 children (ages 1-21 years; 59% females) with recurrent abdominal pain, 142 (24%) were excluded on the basis of their ultimate diagnosis. Of the 458 patients meeting inclusion criteria, 1824 total patient office visits were reviewed. Three hundred eighty-eight (84.6%) did not meet criteria for AM, 20 (4.4%) met ICHD-2 formal criteria for AM and another 50 (11%) had documentation lacking at least 1 criterion, but were otherwise consistent with AM (probable AM). During the observation period, no children seen in this gastroenterology practice had received a diagnosis of AM.
  
  
  CONCLUSIONS
  Among children with chronic, idiopathic, recurrent abdominal pain, AM represents about 4-15%. Given the spectrum of treatment modalities now available for pediatric migraine, increased awareness of cardinal features of AM by pediatricians and pediatric gastroenterologists may result in improved diagnostic accuracy and early institution of both acute and preventative migraine-specific treatments.
authors.affiliation: Division of Pediatric Neurology, Children's Hospital of The King's Daughters, Eastern Virginia Medical Neurology School, Norfolk, VA 23509, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Carson
authors.forename: Donald
authors.initials: D
authors.lastname: Lewis
authors.forename: Marc
authors.initials: M
authors.lastname: Tsou
authors.forename: Erin
authors.initials: E
authors.lastname: McGuire
authors.forename: Brooke
authors.initials: B
authors.lastname: Surran
authors.forename: Crystal
authors.initials: C
authors.lastname: Miller
authors.forename: Thuy-Anh
authors.initials: TA
authors.lastname: Vu
mesh_terms: D015746:Abdominal Pain / Q000145:classification / Q000150:complications* / Q000453:epidemiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008881:Migraine Disorders / Q000145:classification / Q000150:complications* / Q000453:epidemiology*; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult